Cruz-Machado Ana Rita, Barreira Sofia C, Bandeira Matilde, Veldhoen Marc, Gomes Andreia, Serrano Marta, Duarte Catarina, Rato Maria, Miguel Fernandes Bruno, Garcia Salomé, Pinheiro Filipe, Bernardes Miguel, Madeira Nathalie, Miguel Cláudia, Torres Rita, Bento Silva Ana, Pestana Jorge, Almeida Diogo, Mazeda Carolina, Cunha Santos Filipe, Pinto Patrícia, Sousa Marlene, Parente Hugo, Sequeira Graça, Santos Maria José, Fonseca João Eurico, Romão Vasco C
Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.
Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
Front Med (Lausanne). 2022 Jun 13;9:901817. doi: 10.3389/fmed.2022.901817. eCollection 2022.
To identify risk factors for SARS-CoV-2 infection and for severe/critical COVID-19, and to assess the humoral response after COVID-19 in these patients.
Nationwide study of adult patients with inflammatory RMDs prospectively followed in the Rheumatic Diseases Portuguese Register-Reuma.pt-during the first 6 months of the pandemic. We compared patients with COVID-19 with those who did not develop the disease and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. IgG antibodies against SARS-CoV-2 were measured ≥3 months after infection and results were compared with matched controls.
162 cases of COVID-19 were registered in a total of 6,363 appointments. Patients treated with TNF inhibitors (TNFi; OR = 0.160, 95% CI 0.099-0.260, < 0.001) and tocilizumab (OR 0.147, 95% CI 0.053-0.408, < 0.001) had reduced odds of infection. Further, TNFi tended to be protective of severe and critical disease. Older age, major comorbidities, and rituximab were associated with an increased risk of infection and worse prognosis. Most patients with inflammatory RMDs (86.2%) developed a robust antibody response. Seroconversion was associated with symptomatic disease (OR 13.46, 95% CI 2.21-81.85, = 0.005) and tended to be blunted by TNFi (OR 0.17, 95% CI 0.03-1.05; = 0.057).
TNFi and tocilizumab reduced the risk of infection by SARS-CoV-2. Treatment with TNFi also tended to reduce rates of severe disease and seroconversion. Older age, general comorbidities and rituximab were associated with increased risk for infection and worse prognosis, in line with previous reports. Most patients with RMDs developed a proper antibody response after COVID-19, particularly if they had symptomatic disease.
确定新型冠状病毒2（SARS-CoV-2）感染以及严重/危重型冠状病毒病（COVID-19）的危险因素，并评估这些患者感染COVID-19后的体液免疫反应。
在大流行的前6个月期间，对葡萄牙风湿病登记处（Reuma.pt）前瞻性随访的成年炎症性风湿性疾病（RMD）患者进行全国性研究。我们将COVID-19患者与未患该病的患者进行比较，并将轻症/中症患者与重症/危重型COVID-19患者进行比较。在感染后≥3个月测量抗SARS-CoV-2的IgG抗体，并将结果与匹配的对照组进行比较。
在总共6363次就诊中记录了162例COVID-19病例。使用肿瘤坏死因子抑制剂（TNFi；比值比[OR]=0.160，95%置信区间[CI]0.099-0.260，P<0.001）和托珠单抗（OR 0.147，95%CI 0.053-0.408，P<0.001）治疗的患者感染几率降低。此外，TNFi往往对重症和危重症疾病有保护作用。年龄较大、存在主要合并症以及使用利妥昔单抗与感染风险增加和预后较差相关。大多数炎症性RMD患者（86.2%）产生了强烈的抗体反应。血清转化与有症状疾病相关（OR 13.46，95%CI 2.21-81.85，P=0.005），并且TNFi有使其减弱的趋势（OR 0.17，95%CI 0.03-1.05；P=0.057）。
TNFi和托珠单抗降低了SARS-CoV-2感染风险。TNFi治疗也往往会降低重症疾病发生率和血清转化率。年龄较大、存在一般合并症以及使用利妥昔单抗与感染风险增加和预后较差相关，与先前报告一致。大多数RMD患者在感染COVID-19后产生了适当的抗体反应，尤其是那些有症状疾病的患者。
